Cardiac Arrest - Guidelines for Crises in Anaesthesia

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Cardiac Arrest - Guidelines for Crises in Anaesthesia



The probable cause is one or more of: something related to surgery or anaesthesia; the patient’s underlying medical condition; the reason for surgery; equipment failure. The first priority is to start chest compressions, then get help, then find and treat the cause using the guideline.



❶ IMMEDIATE ACTION

 • Declare “cardiac arrest” to the theatre team AND note time.

 • Delegate one person (minimum) to chest compressions 100 min-1, depth 5 cm.

 • Call for help: nearby theatres / emergency bell / senior on-call / dial emergency number.

 • Call for cardiac arrest trolley.

 • As soon as possible, delegate task of evaluating potential causes (Box A).

❷ Adequate oxygen delivery

 • Increase fresh gas flow, give 100% oxygen AND check measured FiO2.

 • Turn off anaesthetic (inhalational or intravenous).

 • Check breathing system valves working and system connections intact.

 • Rapidly confirm ventilator bellows moving or provide manual ventilation.

❸ Airway

 • Check position of airway device and listen for noise (including larynx and stomach).

 • Confirm airway device is patent (consider passing suction catheter).

 • If expired CO2 is absent, presume oesophageal intubation until absolutely excluded.

❹ Breathing

 • Check chest symmetry, rate, breath sounds, SpO2, measured expired volume, ETCO2.

 • Evaluate the airway pressure using reservoir bag and APL valve.

❺ Circulation

 • Check rate and adequacy of chest compressions (visual and ETCO2).

 • Encourage rotation of personnel performing compressions.

 • If i.v. access fails or impossible use intraosseous (IO) route.

 • Check ECG rhythm for no more than 5 seconds.

 • Follow Resuscitation Council (UK) and ERC Guidelines.

 • See Boxes B and C for reminders about drugs and defibrillation.

❻ Systematically evaluate potential underlying problems and act accordingly (Box A).

❼ If there is return of spontaneous circulation, re-establish anaesthesia.



POTENTIAL CAUSES

4 H’s, 4 T’s:

Hypoxia (→ 2-2)

Hypovolaemia

Hypo/hyperkalaemia

Hypothermia

Tamponade (→ 3-9)

Thrombosis (→3-5)

Toxins

Tension pneumothorax



Specific peri-operative problems:

Vagal tone

Drug error

Local anaesthetic toxicity (→ 3-10)

Acidosis

Anaphylaxis (→ 3-1)

Embolism, gas/fat/amniotic (→ 3-5)

Massive blood loss (→ 3-2)



By Association of Anaesthetists @ https://twitter.com/AAGBI

Quick Reference Handbook - Guidelines for crises in anaesthesia 



#CardiacArrest #Checklist #Differential #Anesthesiology #Anesthesia #Intraoperative #Checklist #Diagnosis #Management #Workup 
Contributed by

Dr. Gerald Diaz
@GeraldMD
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG:  https://www.instagram.com/grepmed/ | Twitter: https://twitter.com/grepmeded/
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